DESCRIPTION: Women account for more than half of all new HIV infections globally, with the greatest incidence occurring in African women. Several recently completed biomedical HIV prevention trials in women have reported high incidence rates, as great as 10% at some study sites, despite the provision of comprehensive HIV risk reduction services during the trial. Improving our understanding of predictors of HIV acquisition in African women is urgently needed in order to identify opportunities for intervention among sub-groups of women at greatest risk and inform the scale-up of targeted HIV prevention activities. Empiric HIV risk scores have recently been developed for several populations, including African HIV serodiscordant couples and men who have sex with men in the United States. These tools not only help to identity those at greatest risk of acquiring HIV, they are also being used to guide th implementation of novel HIV prevention activities in these populations. A similar tool has not been developed for African women at risk for HIV. The goal of this proposal is to utilize the accumulated, high-quality databases from completed large-scale HIV prevention trials in women, including VOICE (MTN-003), HPTN 035, MDP301, FEM-PrEP, and ASPIRE (MTN-020), to develop and validate an HIV risk assessment tool for women living in Africa that identifies those who are at greatest risk of acquiring HIV in the next year. The findings from this highly leveraged proposal could have a major impact in the field of HIV prevention science by providing health workers, policy makers and HIV prevention researchers with a tool to identify populations at greatest risk of acquiring HIV, allowing for the opportunity to provide targeted, intensive prevention services to these high-risk women.